Michael A. Hughes, MD
Michael A.
Hughes, MD
Bradley H. Koffman, MD
Bradley H.
Koffman, MD
David T. Shaeffer, MD
David T.
Shaeffer, MD
Bhaswanth Dhanireddy MD
Bhaswanth
Dhanireddy, MD
physician stark
Kelly L.
Rhodes-Stark, MD
Bertram Maidment MD
Bertram W.
Maidment, III, MD

As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

  • TRI, P.A.
  • RADIATION ONCOLOGY CENTER OF OLATHE, LLC
  • LIBERTY RADIATION ONCOLOGY CLINIC

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Our Commitment To Your Privacy

Our practice is dedicated to maintaining the privacy of your protected health information (PHI).  In conducting our business, we will create records regarding you and the treatment and services we provide to you.  We are required by law to maintain the confidentiality of health information that identifies you.  We also are required by law to notify affected individuals following our discovery of a breach of unsecured PHI.  Finally, we are required by law to provide you with this Notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI.  By federal and state law, we must follow the terms of the Notice that we have in effect at the time. We realize that these laws are complicated, but we must provide you with the following important information:

  • How we may use and disclose your protected health information
  • Your privacy rights in your protected health information
  • Our obligation concerning the use and disclosure of your protected health information

The terms of this Notice apply to all records containing your PHI that are created or retained by our practice.  We reserve the right to revise or amend this Notice.  Any revision or amendment to this Notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.

IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT the Privacy Officer, TRI, P.A., 10551 Barkley St., Suite 615, Overland Park, KS 66212, telephone 816-313-2677. A copy of this notice can be located at www.tridocs.com.

The following categories describe the different ways in which we may use and disclose your PHI.

Treatment. Our practice may use your PHI to treat you.  For example, we may ask you to have laboratory tests, and we may use the results to help us complete a treatment plan. We might use your PHI in order to write or order a prescription for you, or we might disclose your PHI to a pharmacy when we order a prescription for you.  Many of the people who work for our practice – including but not limited to our doctors, nurses, therapists – may use or disclose your PHI in order to treat you or to assist others, such as your referring physician or other physicians involved in your treatment.  Additionally, we may disclose your PHI to others who may assist in your care, such as your spouse, children or parents, or designated guardian.

Payment. Our practice may use and disclose your PHI in order to bill and collect payment for the services you may receive from us.  For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment.  We may also use and disclose your PHI to obtain payment from third parties that may be responsible for such costs.  We may use your PHI to bill you directly for services.

Health Care Operations. Our practice may use and disclose your PHI to operate our business.  An example would be that our practice might use your PHI to evaluate the quality of care you receive from us, or to conduct cost management and business planning activities for our practice.  Every effort will be made to insure anonymity.

Appointment Reminders. Unless you object, our practice may use and disclose your PHI to contact you and remind you of an appointment or to change an appointment.

Treatment Options. Our practice may use and disclose your PHI to inform you of potential treatment options or alternatives.

Health Related Benefits and Services. Our practice may use and disclose your PHI to inform you of health related benefits or services that may be of interest to you.

Release of Information to Family/Friends or in an Emergency. Our practice may release your PHI to a family member or friend that is involved in your case, or who assists in taking care of you while you are in treatment.  We may use or disclose your PHI in an emergency treatment situation.

Disclosures Required by Law. Our practice will use and disclose your PHI when we are required to do so by federal, state or local law.

Disclosures of PHI in Certain Special Circumstances. The following categories describe unique scenarios in which we may use or disclose your PHI:

  • Public Health Risks – our practice may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of a) maintaining vital records such as births and deaths, b) reporting child abuse or neglect, c) preventing or controlling disease, injury or disability, d) notifying a person regarding potential exposure to a communicable disease, e) notifying a person regarding a potential risk for spreading or contracting a disease or condition, f) reporting reactions to drugs or problems with products or devices, g) notifying individuals if a product or device they may be using has been recalled, h) notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information, i) notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.
  • Health Oversight Agency – Our practice may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities may include, i.e., investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative and criminal procedures or actions; or other activities necessary for the government to monitor programs, compliance with civil rights laws and the health care system in general.
  • Court or Administrative Order – Our practice may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding.  We may also disclose your PHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
  • Law Enforcement Official – We may release PHI if asked to do so by a law enforcement official a) regarding a crime victim in certain situation, if we are unable to obtain the person’s agreement, b) concerning a death we believe has resulted from criminal conduct, c) regarding criminal conduct at our offices, d) in response to a warrant, summons, court order, subpoena or similar legal process, e) to identify/locate a suspect, material witness, fugitive or missing person, f) in an emergency, to report a crime (including the location or victim(s) of a crime, or the description, identity or location of the perpetrator).
  • Medical Examiner or Coroner – Our practice may release PHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death.  If necessary, we also may release information in order for funeral directors to perform their jobs.
  • Organ Donation – Our practice may release your PHI to organizations that handle organ, eye or tissue donation and transplantation, if you are a donor.
  • Research Purposes – Our practice may use and disclose your PHI for research purposes in certain limited circumstances.  We will obtain your written authorization to use your PHI for research except when an Internal Review Board or Privacy Board has determined that the waiver of your authorization satisfied the following:  (I) the use or disclosure involves no more than a minimal risk to your privacy based on a) an adequate plan to protect the identifiers from improper use and disclosure, b) an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification for retaining the identifiers or such retention is otherwise required by law), and c) adequate written assurances that the PHI will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted; (ii) the research could not practicably be conducted without the waiver; and (iii) the research could not practicably be conducted without access to and use of the PHI.
  • Serious Threats – Our practice may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
  • Military Forces – Our practice may disclose your PHI if you are a member of the US or foreign military forces (including veterans) and if required by the appropriate authorities.
  • Intelligence and National Security – Our practice may disclose your PHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
  • Correctional Institutions – Our practice may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary for the institution to provide health care services to you, for the safety and security of the institution and/or to protect your health and safety or the health and safety of other individuals.
  • Workers’ Compensation – Our practice may disclose your PHI for workers’ compensation and similar programs.
  • Required Authorizations – Our practice is required to obtain your authorization in order to use and disclose your PHI in most instances involving marketing or a sale of your PHI.  Other uses and disclosures of your PHI not described in this Notice may only be made with your written authorization. You generally have the right to revoke your authorization at any time by providing written notice to us at the address provided above.

Your Rights

The federal law that protects the privacy of your health information gives you several rights:

  • You have the right to have a paper copy of this Notice, which will be provided on your first visit, and thereafter upon your request.
  • You have the right to inspect and copy information in your permanent health care record.  If you wish to do so, please contact the Privacy Officer at 816-313-2677 and submit your request in writing.  Our practice may charge a fee for the cost of copying, mailing, or labor/supplies.  If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision.
  • You may also request changes to the information contained in your record, which request may be approved or denied.  If denied, you may submit a written statement disagreeing with the denial which will be kept on file and distributed with all future disclosures of the related PHI.  Please contact the Privacy Officer at the number shown above. 
  • You have a right to a list of those instances where we have disclosed medical information about you, OTHER than for treatment, payment, health care operations or where you specifically authorized a disclosure, when you submit a written request. The request must state the time period desired for the accounting, which must be less than a 6-year period and starting after April 14, 2003. You may receive the list in paper or electronic form. The first disclosure list request in a 12-month period is free; other requests will be charged according to our cost of producing the list. We will inform you of the cost before you incur any charges.
  • You have a right to request, in writing, that medical information about you be communicated to you in a confidential manner, such as sending mail to an address other than your home.  Reasonable requests will be accommodated.
  • You may request, in writing, that we not use or disclose medical information about you for treatment, payment or healthcare operations or to persons involved in your care except when specifically authorized by you, when required by law, or in an emergency. We will consider your request but we are not legally required to accept it, unless the disclosure is to a health plan if the disclosure is for carrying out payment or health care operations and is not otherwise required by law and the PHI pertains solely to a health care item or service for which you, or a person on your behalf other than the health plan, has paid in full.  All written requests or appeals should be submitted to our Privacy Officer listed previously.   

If you believe that any of these rights have been violated, or you disagree with a decision we made about access to your records, you may contact the Privacy Officer at 816-313-2677.  Finally, you may send a written complaint to the U.S. Department of Health and Human Services, Office of Civil Rights (address can be provided to you by the Privacy Officer). Under no circumstances will you be penalized or retaliated against for filing a complaint. 

Effective April 14, 2003; Revised Effective July 1, 2013